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General NPI Number Information
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NPI Number | 1790189348
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Entity Type | Organization
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Legal Business Name | BADRU, INC
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Dates
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Enumeration Date | 10/10/2014
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Last Update Date | 10/10/2014
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Provider Practice Location Address
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Address Line | 805 S CHURCH ST STE 20
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City | MURFREESBORO
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State | TN
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Zip | 37130-4968
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Country | US
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Telephone | 615-962-9011
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Fax | 615-962-9017
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Provider Business Mailing Address
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Address Line | PO BOX 1214
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City | LEBANON
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State | TN
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Zip | 37088-1214
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Country | US
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Telephone | 615-962-9011
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Fax | 615-962-9017
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALEXANDER BADRU
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Credential | M.D.
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Telephone | 615-364-9778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MD41138
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License Number State | TN
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